Provider Demographics
NPI:1902583917
Name:MITCHAM, ASHLEY (PMHNP STUDENT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MITCHAM
Suffix:
Gender:F
Credentials:PMHNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6506
Mailing Address - Country:US
Mailing Address - Phone:619-929-4892
Mailing Address - Fax:
Practice Address - Street 1:834 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6506
Practice Address - Country:US
Practice Address - Phone:619-929-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC354378163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health